From the Guidelines
The patient's symptoms align with New York Heart Association (NYHA) Class II heart failure, characterized by slight limitation of physical activity, comfort at rest, and symptoms such as dyspnea with ordinary physical activity. According to the 2021 ACC/AHA key data elements and definitions for heart failure 1, NYHA Class II is defined as patients with cardiac disease resulting in slight limitation of physical activity, where they are comfortable at rest but ordinary physical activity results in fatigue, palpitation, or dyspnea. The key features of this classification include:
- Slight limitation of physical activity
- Comfort at rest
- Symptoms occur with ordinary physical activity This classification is distinct from other NYHA classes, such as:
- Class I: no symptoms with ordinary activity
- Class III: marked limitation with less than ordinary activity
- Class IV: symptoms present even at rest The NYHA classification is crucial for guiding treatment decisions, monitoring disease progression, and establishing prognosis in heart failure patients, as outlined in the 2021 ACC/AHA report 1. The patient's ability to remain comfortable at rest but experience mild dyspnea with ordinary activities precisely fits the definition of NYHA Class II heart failure, making this the most appropriate classification based on the provided symptoms.
From the Research
NYHA Functional Classification
The New York Heart Association (NYHA) Functional Classification is a system used to classify the severity of heart failure (HF) based on the extent of limitation of physical activity.
Classification of CHF Patients
- A patient with congestive heart failure (CHF) who experiences mild dyspnea on ordinary activity, but is comfortable at rest, can be classified as NYHA Class II 2.
- NYHA Class II is defined as patients having a slight limitation of physical activity but who are comfortable at rest, and for whom ordinary physical activity results in symptoms of HF 2.
- This classification is based on the patient's symptoms and physical activity limitations, which can be measured using clinical outcome assessments, such as patient-reported outcomes and performance outcomes 3.
- The NYHA classification system has been shown to poorly discriminate HF patients across the spectrum of functional impairment, with substantial overlap in values for objective measures, such as NT-proBNP levels, 6-minute walk distances, and left ventricular ejection fraction 4, 5.
Characteristics of NYHA Class II Patients
- Patients with NYHA Class II HF may experience mild dyspnea on ordinary activity, but are comfortable at rest 2.
- They may have a slight limitation of physical activity, but are able to perform daily activities with some difficulty 3.
- NYHA Class II patients may have underlying deleterious effects of neurohormonal imbalance and endothelial dysfunction, which can progress without clinical symptoms 6.
- They are optimal candidates for active intervention, as their HF is at a critical point on the disease progression continuum when untoward changes can be halted or reversed 2.